Clinical Details

Clinical and radiological findings:  This is an opportunistic demonstration of the complexity of neurovascular structures around the proximal radius and their relevance to distal biceps tendon repair. The single incision anterior approach to the distal biceps tendon and radial tuberosity has earned popularity. Nonetheless with bicortical endobutton fixation the posterior interosseous nerve is at significant risk on the dorsal aspect of the proximal radius. There are several papers discussing discussing drill trajectories and endobutton placement to minimize risk to the poster interosseous. Generally speaking staying on the ulnar side of the radius and avoiding anterograde drill trajectories is recommended. Perpendicular or up to 30° retrograde angulation of the drill trajectory brings the endobutton further away from the nerve. The cadaver images attached are simply some from a cadaver lab in which I had the opportunity to lay the antecubital fossa wide open and explore the relationship of the distal biceps tendon with the neurovascular structures of the brachial and radial arteries, the Leash of Henry into the recurrent radial artery, the division of the radial nerve into the superficial and poster interosseous branches, and the relationship of the distal biceps tendon to these. The images show a dissection of the muscle belly of supinator (in green) which is dissected out showing the radial course of the posterior interosseous nerve, and the further image of the dorsoradial aspects of the proximal radius shows a further dissection of the supinator muscle belly and the course of the poster interosseous nerve within it.